ABSTRACT
<p><b>OBJECTIVE</b>To explore the clinical values of ST-segment changes in ST-segment elevated myocardial infarction (STEMI) patients within 24 hours after primary percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>A total of 225 patients with STEMI underwent primary PCI were enrolled, the ST segment resolution 1 hour after PCI was calculated and the patients were divided into group A (n = 135, Sgr;STE resolved ≥ 50%) and group B (n = 90, Sgr;STE resolved < 50%). The patients in group B were further divided into group C (n = 56, Sgr;STE resolved ≥ 50%) and group D (n = 34, Sgr;STE resolved < 50%) according to the ST segment resolution at 24 hours after PCI. TIMI flow after PCI, in-hospital major adverse cardiac events (MACE) and cardiac function about 7 days post PCI were analyzed.</p><p><b>RESULTS</b>Data between group A and group B were similar except the incidence of pre-PCI Killip ≥ II was significantly higher in group B than in group A (37.8% (34/90) vs. 17.0% (23/135), P < 0.05). Incidence of complicated diabetes (P < 0.05), pre-PCI Killip ≥ II (55.9% (19/34) vs. 26.8% (15/56), P < 0.05) and multivessel disease (70.6% (24/34) vs. 35.7% (20/56), P < 0.05) were significantly higher in group D than in group C. TIMI 3 and the opening time of IRA was similar between group A and group B and between group C and group D. The incidence of in-hospital MACE was significantly higher in group B than in group A (14.4% (13/90) vs. 3.0% (4/135), P < 0.05) which was similar between group C and group D.</p><p><b>CONCLUSION</b>Early (1 hour) but not late (24 hours) ST resolution post PCI is related to a favorable clinical outcome in STEMI patients.</p>
Subject(s)
Humans , Angioplasty, Balloon, Coronary , Myocardial Infarction , Percutaneous Coronary InterventionABSTRACT
Objective: To explore the influencing factors of slow blood flow phenomenon after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods: Clinical and PCI angiographic data of 488 patients, who were diagnosed as AMI and received primary PCI in our hospital from Jan 2010 to Jun 2011, were retrospectively analyzed. Patients were divided into slow blood flow group (n=51, TIMI flow ≤ grade 2) and normal flow group (n=437, TIMI flow= grade 3). Their clinical characteristics between two groups were compared. Results: Compared with normal flow group, there were significant reductions in percentages of thrombus aspiration (75.3% vs. 60.8%) and application of platelet glycoprotein IIb/IIIa receptor antagonist (81.7% vs. 68.6%) during PCI, and significant rise in total length of implanted stents [(31.8±12.2) mm vs. (35.7±12.0) mm] in slow blood flow group, P<0.05 all. Multi-factor Logistic regression analysis indicated that percentages of thrombus aspiration during PCI and total length of stents were independent influencing factors for slow blood flow (P<0.05 both). Conclusion: Percentages of thrombus aspiration and total length of stents during PCI are independent influencing factors for slow blood flow.
ABSTRACT
Objective To study the clinical value of serum cardiac troponin Ⅰ (cTnⅠ) in patients with unstable angina pectoris (UAP) and minor myocardial damage.Methods The serum cTnⅠ level of 60 UAP patients (UAP group) were determined.The patients whose cTnⅠ were ≥ 0.1 μ g/L were ascribed to cTnⅠ positive group,and the patients whose cTnⅠ were ＜ 0.1 μ g/L were ascribed to cTnⅠ negative group.The correlation among clinical data,coronary arterial lesions and adverse cardiac events were analyzed.Forty healthy people were selected as control group.Results The positive rate of cTnⅠ in UAP group (35.0％,21/60) was significantly higher than that in control group (0),and there was statistical difference (P ＜ 0.01).The incidence rate of coronary arterial multi-branch lesions and/or severe stenosis in cTnⅠ positive group (19.0％,4/21) was higher than that in cTnⅠ negative group (5.1％,2/39),but there was no statistical difference (P ＞ 0.05).The incidence rate of 90 d adverse cardiac events in cTnⅠ positive group (33.3％,7/21) was significantly higher than that in cTnⅠ negative group (5.1％,2/39),and there was statistical difference (P ＜ 0.01).Conclusions Low-level cTnⅠ demonstrates minor myocardial damage sensitively and specifically.cTnⅠ level detected quantitatively can help to assess prognosis and provide risk stratification of UAP patients.
ABSTRACT
Objective To investigate the relationship between ST resolution and early prognosis of the patients with acute ST-elevation myocardial infarction (STEMI) receiving percutaneous coronary intervention (PCI).Methods A total of 80 consecutive patients with STEMI underwent primary PCI within 12 hours.ST segment elevation amplitude sum was measured and compared before PCI and 1 hour after PCI,and the percentage of declining was calculated.According to thrombolysis in myocardial infarction (TIMI) grading after PCI,the infarction related artery blood flow was recorded and compared.Ten of them who had experienced clear ST resolution (≥30％) before PCI were set aside.Among the other 70 patients,the ST resolution was calculated and the patients were divided into group A (41 cases,ΣSTE resolved ≥50％) and group B (29 cases,Σ STE resolved ＜ 50％).The left ventricular ejection fraction (LVEF),serious adverse cardiac events (MACE,including myocardial infarction,or revascularization,malignant arrhythmia,heart failure and death) in two groups during hospitalization was compared.Results The LVEF in postoperative 1 week in group A was higher than that in group B [(51.90 ± 5.06)％ vs.(46.87 ± 4.01)％,P ＜ 0.05].The incidence of in-hospital MACE during hospitalization in group A was lower than that in group B [7.3％ (3/41) vs.24.1％ (7/29)] (P ＜ 0.05).Conclusions Degree of ST resolution early after recanalization in acute STEMI patients receiving emergency PCI degree can better reflect the level of myocardial tissue perfusion and indirectly predict cardiac systolic function and in-hospital MACE.It can be used as evaluation index of early prognosis.
ABSTRACT
Objective To evaluate the regional cardiac function for patients with coronary heart disease (CHD) with multiple tissue Doppler imaging (TDI) parameters in rest state and to discuss the value of regional cardiac function in diagnosing CHD.Methods Forty-seven patients with chief complain of chest pain underwent TDI examination.Maximum systolic velocity (Sm),maximum early diastolic velocity (Em),maximum late diastolic velocity (Am),isovoluminal contraction time (IVCT) and isovoluminal relaxation time(IVRT) of 16 segments of left ventricle were measured.All the patients underwent coronary angiography (CAG) at the same time.CHD was diagnosed by at least one coronary artery with no less than fifty percent diametric stenosis.Segments dominated by coronary artery with fifty to ninety and more than ninety percent diametric stenosis were defined as moderate and severe lesion segments respectively.Others were non-lesion segments.Results There was no significant difference of sex,age,heart rate,CHD risk factors,left ventricular ejection fraction (LVEF) and E/A among non-CHD (13 cases),one-lesion(11 cases),two-lesion (11 cases) and three-lesion (12 cases)(P ＞0.05).Compared with those in non-lesion segments (390sections),Sm,Em and Em/Am decreased and IVRT prolonged in both moderate lesion segments (162 sections) and severe lesion segments (144 sections) (P ＜ 0.01).IVCT prolonged only in severe lesion segments (P ＜0.05),but not in moderate lesion segments.If setting a criterion that no less than three segments with Sm ＜ 2.50 cm/s and IVRT ＞ 87 ms was for CHD diagnosis,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 79.4％ (27/34),84.6％ (11/13),93.1％ (27/29),61.1％(11/18) and 80.9％(38/47).Conclusions In rest state,regional cardiac function of lesion segments in CHD patients shows changes of decreased systolic and diastolic velocity and prolonged isovoluminal time.Analyzing segmental cardiac velocity and time comprehensively may help to diagnose CHD.
ABSTRACT
Objective To evaluate the coronary lesions with two-dimensional strain echocardiography. Methods Sixty-seven patients with suspected coronary heart diseases who underwent coronary angiography were divided into two groups. Forty-two of them with coronary stenosis ≥70% were considered as patient group, and the other 25 with coronary stenosis ＜50% were regarded as control group. Two-dimensional strain was performed in all patients within 24 h before coronary angiography. Longitudinal systolic strain rate (SRs), early (SRe) and late (SRa) diastolic strain rate, systolic strain (Ss), and time to SRe (T-SRe) were measured and compared. Results Ss, SRs, SRe and SRe/SRa decreased significantly in regions controlled by coronary artery with ≥70% stenosis in patient group compared with those controlled by coronary artery with ＜50% stenosis in control group. SRs and SRe were the independent predictive factors of coronary stenosis ≥70%, and the sensitivity and specificity of SRe ＜0.91 to identify coronary stenosis ≥70% was 72.46% and 89.65%, respectively. Conclusion Two-dimensional strain echocardiography may accurately evaluate the coronary lesions by detecting regional myocardial diastolic function.
ABSTRACT
Backgroud Various antihypertensive drugs decreased peripheral arterial pressure similarly,while their effects on central arterial pressure may be at variance.The studies of the effect on central arterial pressure of antihypertensive drugs,especially the effect ? adrenoreceptor blockers was paucity.Objective To investigate the effect of ? adrenoreceptor blocker metoprolol tartrate on central and peripheral arterial pressure in patients with hypertension.Methods Fifty patients with primary hypertension who underwent percutaneous coronary angiography were recruited.Radial arterial and ascending aortal pressure as peripheral and central blood pressure were determined.Patients were chewing 25-50 mg metoprolol tartrate or 10 mg nifedipine during the catheterization.Results After administering metoprolol tartrate,the magnitude of decreases in peripheral arterial pressure were significantly(P0.025).Both peripheral and central arterial pressure decreased significantly after administering nifedipine(P0.025).Conclusion Despite similar decrease of peripheral arterial pressure,the decrease magnitude of central arterial pressure by metoprolol tartrate was significantly smaller than that by nifedipine.
ABSTRACT
Objective To study the relative factors of hypotension after recanalization of infarction related artery(IRA) during emergency PCI for patients with acute myocardial infarction.Methods We retrospectively analyzed the clinical information and the coronary angiograph of 245 consecutive patients with primary acute myocardial infarction undergoing emergency PCI at the first affiliated hospital of China Medical University from January 2003 to September 2006.Twenty seven patients with blood pressure elevated higher than 140/90 mm Hg after reperfusion were excluded.The remaining 218 patients were catagorized into the hypotension group(BP≤90/60 mm Hg,n=102) and the normal blood pressure group(n=116) according to the blood pressure level after reperfusion during emergency PCI.The relative factors of hypotension were analyzed through logistic regression test.Results Compared with the normal blood pressure group,patients in the hypotension group had higher incidences of old age(age ≥60 yrs),heart failure(killip grades≥grade 2),inferior wall or right ventricular infarction,right coronary artery lesions,proximal or total occlusion lesions,multivessal disease and TIMI blood flow≤grade 1 in the IRA after recandization.Mortality rate was also higher in the hypotension group(P1).Conclusion Old age(age ≥60),inferior wall infarction,killip grades≥2,right coronary artery lesions,proximal or total occlusion lesions are the risk factors of hypotension after recanalization of IRA during emergency PCI.The presence of hypotension is correlated with the increase of in hospital mortality.
ABSTRACT
Objective: Our aim was to investigate the effects of phenylephrine (PH) and angiotensin Ⅱ (AT) on reperfusion arrhythmias in the isolated rat heart and its mechanism. Methods: Isolated rat hearts were subjected to dual coronary perfusion. After 15 minutes of aerobic perfusion of both coronary beds, flow to the left coronary bed infused selectively into that bed. Ventricular tachycardia (VT) and fibrillation (VF) were analyzed 5 minutes after reperfusion. Results: The reperfusion arrhythmias was significantly exacerbated by PH; however, AT alone did not have the same effect. The selective Na+/H+ exchanger (NHE) inhibitor, HOE642, which was infused along with PH, reversed the proarrhythmic effects of PH. The specific protein kinase C (PKC) inhibitor GF109203X (GF) infused along with PH can only partially reverse the proarrhythmic effect of PH. The AT2 receptor inhibitor PD123319 (PD) alone increased the incidence of reperfusion-induced arrhythmias. However, no statistical significance showed. Combination of PD and AT significantly increased the incidence of reperfusion-induced arrhythmias. Conclusion: Activation of α1-adrenoceptor can exacerbate reperfusion-induced arrhythmias. The AT1 receptor activated by AT can exacerbate reperfusion-induced arrhythmias. The activation of AT2 receptor may reduce reperfusion-induced arrhythmias.
ABSTRACT
Objective To investigate the clinical value of the intra-cronary interventional techniquein the treatment of coronary heart disease. Methods The 110 patients with coronary heart disease weretreated with 63 balloon angioplasties and 47 coronary-stent implantations. Results The ballloon angioplasty was made in 94 coronary lesion arteries with success of 88 vessels. In the following up periods of2-72 months, the angina pectoris and acute myocardial infarction were occurred respectively in 11 and2 cases (24.07 % ). The 63 stems were implanted into 59 coronary lesion arteries with success of 58 vessels. All patients were followed up for 2~12 months and the angina pectoris were occurred in 6 cases(13.3 % ). Conclusion The intracoronary intervetional technique was an effective method for treatmentof the coronary heart disease.